[Drug combination therapy for children infected with HIV/AIDS--own experience]

Background antiretroviral therapy (HAART) for primary perinatal infection with three drugs is recommended because it provides the best opportunity to preserve immune function and delay disease progression. The aim of HAART is to maximally suppress viral replication, preferably to undetectable levels. We evaluated the safety and efficacy of a three drug regimen in a small group 7 of maternally infected and 1 probably nosocomial infected children from 1998.

Triple drug combination regimen the most often was composed of: either AZT + 3TC + NFV, ddi + d4T + NFV, or ddI + d4T + NVP. This therapy was monitored by serial measurements of peripheral-blood CD4, viral load (VL), biochemical parameters and clinical observation. Lately also genotyping resistance and phenotyping drug susceptibility were investigated in the patients with high > 5000 kopii/ml VI.

The three-drug regiment was well tolerated in 6/8 patients. Hematological abnormalities (severe anaemia after AZT) was noticed in 1 patient and hyperlipidemia in the second one (after Nelfinavir). 3TC resistance or genotyping mutations were observed in 4/8. These patients had low or undetectable VL during a long time, but lately after > 1 year therapy VL has risen. In all 8 patients clinical and immunological parameters are good, stabile. The opportunistic infections weren't observed.

Although further observations are needed., it appears that in HIV infected children combined treatment is well tolerated and has sustained efficacy against HIV.